HEENT

ELENA T. SOLIS MD MPH

HEAD
LANDMARKS of the FACE
NECK
.
 Important structures of the neck that need to
be evaluated:
TRACHEA
THYROID GLAND
LYMPH NODES
NECK VESSELS
Examination: HEAD and NECK

 HEAD
1. Observe head position
2. Inspect facial features, including the ff:
a) Symmetry
b) Shape
c) Unusual features
d) Tics
e) Characteristic facies
3. Inspect skull and scalp for the ff:
a) Size
b) Shape
c) Symmetry
d) lesions
e) Hair pattern
4. Palpate the skull and scalp, noting the ff:
a) Symmetry
b) Tenderness
c) Scalp movement
d) Palpate the patient’s hair
6. Palpate the temporal arteries, noting the ff:
a) Thickening
b) Hardness
c) Tenderness
7. Auscultate the temporal arteries for bruits
NECK

 Inspect the neck

a. In the usual anatomic position

b. In slight hyperextension
c. As the patient swallows
1.Inspect the neck for :
- symmetry
- size ( long or short)
- deformity
- masses, webbing
- alignment of trachea
- jugular vein distention
- carotid artery prominence
2. Evaluate the range of motion of the neck
3.Palpate the neck for:
a) Tracheal position
b) Carotid pulsation
c) Lymph nodes
d) Thyroid gland
TRACHEA

 Inspect the trachea for any deviation from its

usual midline position
 Then feel for any deviation by placing your
finger along one side of the trachea and note
the space between it and the SCM.
 Compare it with the other side. The spaces
should be symmetrical. If asymmetrical there
is deviation
LYMPH NODES

 The examiner should stand behind the seated

patient

 Enlarged lymph nodes maybe visible by

inspection esp. with oblique light
 Examination is primarily by palpation

 Use the pads of both index and middle fingers

as you move the skin over the underlying
tissues in each area rather than moving your
fingers over the skin in a rotatory fashion
 Palpate the lymph nodes for the ff:
a) Size
b) Consistency
c) Tenderness
d) Warmth
e) Mobility
THYROID GLAND

 Examination of the thyroid gland involves

inspection, palpation and auscultation
 Inspection
-Patient should be seated
-Inspect the lower half of the neck in the
anterior triangles
-Have him swallow or sip a glass of water to
note any ascending mass in the midline or
behind the SCM
- If the patient is obese or has a short neck , tilt the
head back to be supported by his hands clasped
at the occiput.

-Ask him to swallow while in this posture

-The thyroid gland, thyroid cartilage, and cricoid

cartilage all normally rise as the person swallows
 Palpation
- palpation of the thyroid gland mandates
a gentle touch
-best done from behind the patient
- cricoid cartilage is the basic landmark
for examination
 Palpate the thyroid gland for :
- size
- shape
- symmetry
- consistency of the gland, tenderness
- presence of nodules
- movement
2 methods of palpation:
a) Palpation from behind
b) Frontal palpation of the thyroid gland
 Auscultation
CAROTID PULSATION
TEMPOROMANDIBULAR JOINT
THYROID GLAND
SYMPTOMS

HEADACHE
 Tension Headaches
 - Mild or moderate discomfort, a heavy feeling, a
sense of pressure, tight band, steady rather than
throbbing
-usually bilateral, gradual in onset, duration
variable
- related to sustained muscular tension
- improved by massage, mild analgesics,
application of hot packs,relaxation
 Vascular Headaches
- produced by segmental arterial
constriction and dilatation

- characterized by their intermittence and

the throbbing pain
 Vascular Headaches
1. Migraine Headaches
2. Cluster Headaches
3. Hypertensive Headache
4. Toxic Vascular Headaches due to fever, toxic
substances or drug withdrawal
5. Temporal Arteritis headache
 Migraine Headache
 Classic Migraine
4 phases
1. Prodrome- an attack is often triggered
by period of anxiety, tension,
bright light, loud noise,
skipped meals, foods and
beverages, strong odors and
change in sleep patterns
2. Aura – visual disturbances
3. Headache
- frequently present on awakening
-severe throbbing, boring, aching
headache typically frontal or temporal one or
both sides
- fairly rapid,reaching a peak in 1-2 hrs several
hrs to 1-2 days duration
-
 - headache maybe increased in the reclining
position, shaking the head, coughing or
straining at stool
- headache maybe relieved by quiet, dark
room ;sleep
- Associated symptoms are N/V, photophobia,
annoyance for odors,
maybe normal or cold limbs and pale skin

4. Recovery
 Traction –Displacement Headaches
- headaches may be throbbing when arteries
are involved ; otherwise the pain is steady

- headaches are often intensified by

movements of the head, certain postures,
rapid changes in the pressure of CSF
Traction –Displacement Headaches
1. Brain tumor
2. Brain abscess
3. Subdural hematoma
4. Cerebral hemorrhage
5. Lumbar puncture headache
 Inflammatory headache
- inflammation near a pain sensitive
structures within the cranium

1. Bacterial meningitis
- acute generalized headache, throbbing or
constant, acc. by fever and stiff neck
 Localized Headaches
1. Paranasal Sinusitis
2. Eyestrain
 Pain in the Face
1. Trigeminal Neuralgia ( Tic Doulourex)
2. Herpes Zoster
Facial pain

 Trigeminal neuralgia (Tic Doulourex)

- Compression of the 5th nerve root by a vessel
or a neoplasm
- 2nd maxillary division ,commonly involved
- Light touch, chewing, sneezing provokes a
paroxysm
- Hot lancinating ,periodic, unilateral pain
 Herpes zoster
- sharp , burning, unilateral pain along the
distribution of a branch of the trigeminal
nerve
NECK
 Stiff neck

1. Congenital
Torticollis ( wryneck)
-due to hematoma or partial rupture of the
muscle at birth
2. Acquired

a. infectious
b. traumatic/mechanical
c. neoplastic
d. neurolgic
e. metabolic
 Nongoitrous cervical masses
Midline cervical mass
- Thyroglossal cysts
- Suprahyoid cysts
- Subhyoid cysts
- Pyramidal lobe of thyroid
- Thyroid cartilage cysts
- Cricoid cartilage cysts
Lateral cervical cyst
- Branchial cyst
- Hygroma
- Carotid body tumor
- Cavernous hemangioma
- Branchial fistula
- Zenker’s diverticulum ( pharyngeal pouch)
Thyroid

 Thyroid enlargement ( GOITER)

- patient complains of fullness of mass in the

neck

- evaluation of the TG includes a description of

the gland and a functional assessment
 characterize the enlarge thyroid as diffuse,
focal, nodular, or smooth
 Types of thyroid enlargement
1) Diffuse enlargement
- diffusely enlarged gland includes the isthmus
and the lateral lobes but no discrete palpable
nodules
- causes: Grave’s disease,
Hashimotos thyroiditis,
endemic goiter
2) Multinodular goiter
- enlarged TG that contains 2 0r more
identifiable nodules
3) Single nodule
- clinically , maybe a cyst, a benign tumor, or
one nodule within a multinodular gland.
- also raises the question of malignancy
 Thyroid syndromes

- excess or deficit of thyroid hormones alter

the physical structure of the body to produce
physical signs

- make an assessment of the state of thyroid

hormone production

-
 Thyroid syndromes
a) Hyperthyroidism
- overproduction of the thyroid hormone or
excessive thyroid medication

b) Hypothyroidism
- due to iodine deficiency, deficit of thyroid
hormone, excessive dose of thiouracil drugs
 Symptoms of Thyroid Dysfunction
HYPERTHYROIDISM HYPOTHYROIDISM
Nervousness Fatigue ,lethargy
Weight loss despite increased appetite Modest weight gain with anorexia
Excessive sweating and heat intolerance Dry coarse skin and cold intolerance
Palpitations Swelling of face, hands, and legs
Frequent bowel movements Constipation
Muscular weakness of the proximal type Weakness, muscle cramps, arthralgias,
and tremor paresthesias, impaired memory, hearing
 Signs of Thyroid Dysfunction
HYPERTHYROIDISM HYPOTHYROIDISM
Tachycardia or atrial fibrillation Bradycardia and in late stages
hypothermia
Increased systolic and decreased diastolic Decreased systolic and increased diastolic
pressures blood pressure
Hyperdynamic cardiac pulsations with an Intensity of heart sounds sometimes
accentuated S1 decreased
Warm ,smooth, moist skin Dry ,coarse , coarse, cool skin, sometimes
yellowish from carotene, nonpitting
edema, loss of hair
Tremor, proximal muscle weakness Impaired memory, mixed hearing loss,
somnolence, peripheral neuropathy,
carpel tunnel syndrome
With grave’s disease , eye signs like stare, Periorbital puffiness
lid lag, exophthalmos
LYMPH NODES

 Lymphadenopathy
- enlargement of one or more lymph nodes

- may be generalized ( involving 3 or more

node groups) or localized
1. Generalized lymphadenopathy
a. syphilis
b.rubella
c. Infectious mononucleosis
d.HIV
e.Generalized furunculosis
2. Localized lymphadenopathy
- when an enlarge LN is found, carefully
examine the drainage region for a primary
lesion or possible infection

eg. Ear infection will usually drain to the

preauricular ,tonsillar or deep cervical nodes
a. Occipital
- Roseola
- scalp infection
- seborrheic dermatitis
- tick bite
- Tinea capitis
b. Auricular
- erysipelas
-Herpes Zoster opthalmicus
- rubella
- Squamous cell carcinoma
- styes or chalazion
- tularemia
c.Cervical
- Cat-scratch fever
- tonsillitis
- facial or oral cancer
- TB
- infectious mononucleosis
- rubella
- rubeola
-thyrotoxicosis
- Varicella
d. Submaxillary and submental
- cystic fibrosis
- dental infection
- gingivitis
- glossitis
 Chronic localized cervical lympadenopathy
a) TB
b)Hodgkin disease
c) Actinomycosis
d) Virchow node ( sentinel node)
- enlargement of a single LN usually in the
L supraclavicular area.
Trachea

 Tracheal displacement
1) Retrosternal goiter
2) Pneumothorax
3) Any mass
SIGNS
 Head size ,shape,lesions

Hydrocephalus Scars Head tumor

Hair distribution

 Alopecia areata
 Facial assymetry
Color of the face
Facial edema
 lesions mass
 Startled expression

Ptosis
Facies

 Expression or appearance of the face and

features of the head and neck that when
considered together, are characteristics of a
clinical condition or syndrome
 Acromegaly

 -large head
 - forward projection of jaw
 - protrusion of frontal bone
 Hyperthyroid Facie
 - fine moist skin
 - fine hair
 - prominent eyes
 - lid retraction
 - startled expression
 (R) Facial Palsy
 - facial assymetry
 - eyelid not closing completely
 - loss of nasolabial fold
 - drooping corner of the mouth
FACIAL PALSY
 NECK
 Neck mass
 Enlarged infected Lymph nodes
THANK YOU